Tue. Jul 5th, 2022

Health authorities around the world are continuing to investigate an outbreak of severe and unexplained hepatitis in children, with about 450 cases now reported worldwide.

Hepatitis is an inflammation of the liver, often caused by a viral infection and generally rare in healthy children.

The spate of unusual cases first came to global attention in April when UK health authorities reported higher than average rates of liver inflammation in children where the typical causes – hepatitis viruses A, B, C, D and E – were not detected.

Such cases, though not unheard of, are generally rare, says Melbourne gastroenterologist Winita Hardikar.

“We would probably see five or six cases of severe, non AE hepatitis in children each year, and one or two would need a transplant,” said Professor Hardikar, head of the liver and intestinal transplant unit at the Royal Children’s Hospital in Melbourne.

While most children recover from hepatitis, the severity of recent cases – most of which have occurred in children under the age of 5 – has concerned experts.

Most children have reported gastrointestinal symptoms including abdominal pain, diarrhea and vomiting, before developing jaundice, a condition in which the skin and whites of the eyes turn yellow.

Microscope image shows orange circles on purple background.
Hepatitis is typically caused by the family of hepatitis viruses, but can also be sparked by alcohol use, exposure to toxins, or other pathogens.(CDC: Dr. Erskine Palmer)

In roughly 10 per cent of cases, children have required liver transplants, and according to the European Center for Disease Prevention and Control, 11 children have died.

Cases have been identified in more than 20 countries, including in the United States, Israel, Indonesia and Japan.

“We have not seen it yet [in Australia] “But obviously we’ve been alerted and we’ll be on the lookout for it,” Professor Hardikar said.

What could be behind the unusual hepatitis?

After health authorities failed to find any evidence of the hepatitis viruses that most commonly cause liver inflammation, they began to look for common environmental exposures and toxins that might explain the outbreak.

So far, none have been identified, but it’s early days and “everything is still on the table”, virologist Ian Mackay says.

“At the moment, the leading hypothesis is that it’s something likely to be infectious,” said Dr Mackay from the University of Queensland.

“The hardest thing is that there is no epidemiologically link to these cases – nothing to suggest they’re being infected in the same household or same school.

But health authorities in the UK have identified a number of clues and begun to narrow their focus.

“The leading hypotheses remain those which involve adenovirus,” they wrote in their most recent technical briefing.

“However, we continue to investigate the potential role of SARS-CoV-2 and to work on ruling out any toxicological component.”

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